Organization · NPI-2

42 North Dental Care, PLLC

Dentist · Waltham, MA

NPI number1366017394
StatusActive
Last updated in NPPESMay 21, 2021

Details

NPI
1366017394
Entity type
Organization (NPI-2)
Legal business name
42 North Dental Care, PLLC
Organization subpart
No
Enumeration date
May 21, 2021
Certification date
May 21, 2021
Last updated
May 21, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentist––Yes

Practice location

200 5th Ave Fl 3
Waltham, MA 02451-8759

Phone 781-647-0772

Mailing address

200 5th Ave Fl 3
Waltham, MA 02451-8759

Phone 781-647-0772

Authorized official

Michael Angelo Scialabba
Chief Clinical Officer
5615122709

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